The American journal of emergency medicine
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Management of patients with syncope lacks standardization. We sought to assess regional variation in hospitalization rates and resource utilization of patients with syncope. ⋯ Significant regional variability in hospitalization rates and ED service charges exist among patients with syncope. Standardizing practices may be needed to reduce variability.
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Multicenter Study Comparative Study Observational Study
Comparison of 4 tests' utility for predicting need for emergency department care in patients with alcohol-related complaints.
Intoxication is a common presenting complaint in emergency departments (ED), but many patients with intoxication do not need emergency care. Three screens (BLINDED, Brown, and San Francisco) attempt to determine which intoxicated patients can be triaged to a lower level of care. ⋯ The three formal screens and provider gestalt performed similarly.
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Multicenter Study
Serum total carbon dioxide as a prognostic factor for 28-day mortality in patients with sepsis.
Metabolic acidosis is commonly associated with the disease severity in patients with sepsis or septic shock. This study was performed to investigate the association between serum total carbon dioxide (TCO2) concentration and 28-day mortality in patients with sepsis. ⋯ Serum TCO2 concentrations of 20 mmol/l or less were associated with 28-day mortality in patients with sepsis.
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Comparative Study
Comparison of MPL-ANN and PLS-DA models for predicting the severity of patients with acute pancreatitis: An exploratory study.
Acute pancreatitis (AP) is a common inflammatory disorder that may develop into severe AP (SAP), resulting in life-threatening complications and even death. The purpose of this study was to explore two different machine learning models of multilayer perception-artificial neural network (MPL-ANN) and partial least squares-discrimination (PLS-DA) to diagnose and predict AP patients' severity. ⋯ The results demonstrated that the MPL-ANN model based on routine blood and serum biochemical indexes provides a reliable and straightforward daily clinical practice tool to predict AP patients' severity.
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Case Reports
T-wave inversions in inferior ST-elevation myocardial infarction - A case of "inferior Wellens sign".
Although T-wave inversions are nonspecific, in the appropriate clinical setting, the pattern of negative biphasic T-waves or T-wave inversion in V2-V3 can indicate critical stenosis of the left anterior descending coronary artery (i.e. "anterior Wellens sign"). Recently tall T-waves in V2-V3 have been reported in association with posterior reperfusion (i.e."posterior Wellens sign"). Less commonly, negative biphasic T-waves or T-wave inversions in the inferior leads have been reported in association with critical stenosis of the right coronary artery (RCA) or left circumflex artery (LCx). We present a case where T wave inversions (i.e. "inferior Wellens sign") and a tall T-wave in V2-V3 (i.e. "posterior Wellens sign") preceded the development of an inferior-posterior ST-elevation myocardial infarction (STEMI). ⋯ A 37-year-old man presented to the Emergency Department for one day of chest pain. On arrival, his pain had resolved, and his 1st ECG showed inverted/biphasic T-waves in lead III and aVF and a tall T wave in V2-V3. Three- and one-half hours after arrival, his chest pain returned and his ECG showed an inferior-posterior STEMI. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: New, focal T-wave inversions in an anatomic distribution may be an early warning sign of impending myocardial infarction. Careful attention to the T-waves during asymptomatic periods may assist in identifying patients that may have critical stenosis of an underlying coronary artery. In this case, T-wave inversions in the inferior leads, along with a tall T-wave in V2-V3, were seen prior to the development of an inferior-posterior STEMI.